3. In Vitro Fertilization (IVF)

It is a method of assisted reproduction that involves combining an egg with sperm in a laboratory dish. If the egg fertilizes and begins cell division, the resulting embryo is transferred into the woman's uterus where it will hopefully implant in the uterine lining and further development. IVF bypasses the fallopian tubes and is usually the treatment choice for women who have badly damaged or absent tubes, blocked tubes. IVF/ET was first successfully used in human over 25 years ago. Since then, more than 100,000 children have been conceived using this technology. IVF is a procedure designed to enhance the likelyhood of conception in couples from whom other fertility therapies have been unsuccessful or are not possible.

It is a complex process involving multiple steps resulting in the insemination and fertilization of oocytes (eggs) in our laboratory. The embryos created in this process are then placed into the uterus for potential implantation.

BFC is a centre providing IVF service.

At this centre, all couples will discuss with a consultant and staff about the timing and plans for their treatment which will be tailored to suit their convenience as much as possible.

We give general information to patient about treatment details, treatment purpose, side effects and risks of treatment, fitness for treatment (i.e. weight , BMI ), alternative treatment, duration of therapy, effect of cigrettes, alcohol and drugs, need the screening for HBV, HCV, HIV, VDRL, risks of OHSS, cost, implication, freezing of surplus embryos, risk of failure to thaw, incidence of abnormal birth (natural background risk ), chances of success, detail of the cost, comparative cost of different treatments and cost of embryo storage. We also discuss about consent forms .

1. Place of treatment

Treatment shall take place at BFC.

2. Type of payment

Payment must be received by installment at BFC.

3. Duration

About 2-3 weeks (individual variation may take place depending upon individual response and regieme, etc.)

4. Clinical procedure for HIV, HBs Ag, HCV Ab, VDRL

Present policy at BFC dictates that all couples preceeding to procedure such as IUI, IVF must be tested HIV, HBsAg, HCV Ab, VDRL. The policy states that both partners must test negative for HIV at the start of the procedure. For HBs Ag , HCV Ab and VDRL positive cases, all couples will be explained about the chance of having a baby with Hepatitis B or C or VDRL and risks of the procedure. VDRL postive cases need to treat before starting the procedure.

5. Procedures steps for  for IVF

(1) Consultation with a fertility specialist.

The first step is to schedule a consultation with a fertility specialist. The doctor will review the medical history, perform a physical exam, and discuss whether patient is a potential candidate for IVF.

(2) The first official day of the treatment cycle is the first day of the period and need to inform to team about the menses. On the second or third day of the period, healthcare provider will likely order hormone blood test and a transvaginal ultrasound to check antral follicle count. (Need routine screening blood tests for both couple)

 (3) If the result of ultrasound and hormone test are fine, patient will be starting the hormonal injection on day 3 of period. The dose and type of medicine depend on patient’s age, hormone results, BMI, AMH and past history of hormone injection in previous stimulation cycle. Patient may need the hormonal injection for 9 to 10 days.

(4)During ovarian stimulation, the doctor will monitor the growth and development of follicles with transvaginal ultrasound scan on day 5 of injection and then as required. And Estradiol level will be monitoring on day 4 of injection and day 8 of injection then checking Estradiol and Progesterone hormone on the day of HCG triggering.

(5) Monitoring the cycle is very important. This is how the doctor will decide how to adjust the medications. Patient may need to increase or decrease dosage. Around Day 6 of the injection, patient will be adding a new medicine as antagonist to prevent premature ovulation everyday up to trigger day. (6) The HCG injection is given when three or more follicles reached 17 mm. Then decision to trigger may varies for individual person.

(7) Couple need to sign a consent form dealing the OPU procedure before starting hormone stimulation and also need evidence of marriage from the couple .

(8) About 34 to 36 hours after receiving the trigger shot, the egg retrieval will take place. Before the retrieval, an anesthesiologist will give the intravenous medication to feel the patient relaxed and pain free. Usually, a light sedative is used. This isn't the same as general anesthesia, which is used during surgery. Side effects and complications are less common. Once the medications take effect, doctor will use a transvaginal ultrasound to guide a needle through the lateral wall of the upper vagina, up to the ovaries. OPU procedure will use the needle to aspirate the follicle. These oocytes will be transferred to the embryology lab for fertilization. Patient will be starting luteal support 24 hour after egg retrieval if progesterone level is normal and Estradiol level is not too high on HCG day and may not be the symptom of OHSS.

(9) About three to five days after the retrieval and there is no symptoms of OHSS, an embryologist will identify the healthiest looking embryos. Single embryo transfer will usually take place apart from exceptional cases. Embryo transfer doesn’t need anaesthesia. Embryo transfer is taken under transabdomenal ultrasound guidance with full bladder. During the embryo transfer, a thin tube (Embryo Transfer catheter), will be passed through the cervix. Patient may experience very light cramping but nothing more than that. The doctor will transfer the embryo through the catheter, along with a small amount of fluid. After the transfer, patient may rest for 15 minutes if she wishes and then go home. If there are good quality embryos left, patient may be able to freeze them. More luteal support may be added and serum progesterone will be checked accordingly.

 (10) About 14 days after the embryo transfer, a pregnancy test is ordered. This is usually a blood test. If the test is positive, patient may need to keep taking luteal support upto 10 to 12 weeks of pregnancy. Follow up with ultrasound scan every 2 weeks.

For remaining embryos,

Uncleaved and degenerated embryos are disposed of. Remaining embryos (cleaved) are frozen if there is a sufficient quality for freezing.